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Flashcards in Incontinence Deck (12)
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1

Define urinary incontinence

Outline the different types

Urinary incontinence is the involuntary leakage of urine

  • Stress: involuntary leakage on exertion (eg. sneezing, coughing, exercise, lifting, laughing) due to incompetent sphincter.
  • Urge: involuntary leakage accompanied by, or immediately preceded by, urgency of micturition due to hyperreflexia of detrusor muscle.
  • Overflow: usually due to chronic bladder outflow obstruction.
  • Functional: disability or social constraints prevent reaching the toilet in time.

2

What is overactive bladder syndrome?

How does it relate to urinary incontinence?

OAB = Urinary urgency ± urge incontinence (wet vs dry)

Often associated with frequency and nocturia

3

State four risk factors for urinary incontinence

  • Older age
  • Obesity
  • Stool impaction and chronic constipation
  • Smoking
  • Female-specific:
    • Pregnancy and vaginal delivery
    • Atrophic vaginitis; hysterectomy; prolapse
  • Male-specific: Prostatectomy
  • Chronic UTIs and DM
  • Obstruction: prostate enlargement, pelvic tumours
  • Neurological disease: stroke, dementia, Parkinson's disease
  • Medication: amlodipine; diuretics; ACEi; opioids

4

State two complications of urinary incontinence

  • Impaired QoL
  • Falls; fractures
  • Mental health: anxiety, depression
  • Social isolation
  • Loss of sleep
  • Sexual problems
  • Skin irritation and breakdown
  • Financial problems

5

What are the key points to assess in a history of urinary incontinence?

  • HPC
    • Categorise the type of urinary incontinence
    • Ask if onset upon sneezing, coughing, lifting
    • Ask if any urgency
    • Determine frequency during day/night
    • Loss of control, feeling of incomplete emptying, dysuria
  • Impact of neurological disease if present
    • Mobility, hand co-ordination
    • Cognitive function
    • Social support and lifestyle
  • Full obstetric history
  • Bladder chart for 3+ days
  • SHx
    • QoL and sexual dysfunction
    • Functional status and access to toilet
  • Medications and bowel habits

6

What examination findings should be assessed in urinary incontinence?

Women

  • Digital assessment of pelvic floor muscle contraction
  • Bimanual/vaginal examination for prolapse
  • Visible signs of vaginal atrophy
  • Abdominal, pelvic, and neurological examinations

Men

  • DRE: prostate, rectal pathology, and pelvic floor muscles
  • Abdominal, pelvic, and neurological examinations

7

Request three investigations for urinary incontinence

  • Urine dipstick: blood; glucose; protein; leukocytes; nitrites
    • Exclude/treat suspected UTIs
  • Post-void residual volume
  • Symptom and QoL assessments
  • Bladder diaries for >3/7
  • Urodynamic studies
  • Consider AKI screen: U+Es; eGFR

8

Outline the lifestyle management of urinary incontinence

Lifestyle management options are the cornerstone.

  • Advise modifying fluid intake
  • Weight loss if BMI >30
  • Absorbent containment products as adjunct/coping strategy

Planned-toileting for patients with cognitive impairment

9

Outline the management of stress urinary incontinence

  • Pelvic floor exercises 3x8 daily
  • Surgery: colposuspension; fascial sling
  • Duloxetine:
    • If surgery declined/unsuitable
    • Significant anticholinergic adverse effects

10

Outline the management of urge urinary incontinence

  • Caffeine reduction; dietary advice
  • Bladder training for 6+ weeks
  • Add:
    • Antimuscarinic: Oxybutynin; tolterodine; darifenacin
    • Mirabegron
    • Intravaginal oestrogen if vaginal atrophy
    • Consider desmopressin for nocturia

11

Outline the management of overflow urinary incontinence

  • Relief of obstruction
    • eg. Tamsolusin, Finasteride, TURP
  • Self-catheterisation:
    • Persistent retention; refractory incontinence

12

List four risk factors for faecal incontinence

  • Advancing age
  • Diarrhoea
  • Urinary incontinence
  • Multiparity; vaginal delivery with sphincter tear
  • Neurological or spinal issues
  • Severe cognitive impairment or intellectual disability